Gallbladder: Inflammatory Conditions

INFLAMMATORY CONDITIONS

Acute cholecystitis is an acute inflammation of the gallbladder, usually caused by cys-tic duct obstruction by gallstones. It can present with biliary colic, right upper quad-rant tenderness on palpation, nausea and vomiting, low-grade fever, and leukocytosis. Complications include gangrene of the gallbladder, perforation and peritonitis, fistula formation and gallstone ileus (small bowel obstruction by a large gallstone). Acute acalculous cholecystitis is associated with surgery, trauma, and sepsis.

Chronic cholecystitis is ongoing chronic inflammation of the gallbladder, usually caused by gallstones. Well-developed examples show stromal and mural lympho-cytic and plasmacytic infiltrates. Macrophages and granulomas may also be present. The wall is thickened.

Ascending cholangitis is a bacterial infection of the bile ducts ascending up to the liver, usually associated with obstruction of bile flow oftentimes from bile duct stones. It presents with biliary colic, jaundice, high fever, and chills. The infecting organisms are usually gram-negative enteric bacteria.